MEDICARE: ALVIN BEXTEN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	002985	MO

General Provider Information

NPI Number	:	1114965662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALVIN BEXTEN LCSW

Provider Business Mailing Address
First Line	:	1800 COMMUNITY
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-8804
Country	:	US
Telephone Number	:	660-885-8131
Fax Number	:

Provider Business Practice Location Address
First Line	:	3016 DUPONT CIR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-6188
Country	:	US
Telephone Number	:	888-403-1071
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	10/09/2018

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